Acceptance

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Acceptance Commitment TherapyWith Couples

• Dr Russ Harris, M.B.B.S., M.A.C.Psych.Med.
• Medical Practitioner, Psychotherapist
• russharris_at_actmindfully.com.au
• www.actmindfully.com.au

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Aims of the Workshop

• ACT conceptualisation of relationship issues
• ACT interventions for relationship issues
• Interspersed with experiential exercises

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ACT Case Conceptualisation

• 2 simple questions
• 1. What sort of relationship do(es) the client(s)
  want to build?
• 2. What stands in their way?
• - 2a) What are they fused with?
• - 2b) What are they avoiding?
• - 2c) What ineffective actions are they taking?

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Taking A History

• Whats the problem?
• -Can you tell me about a recent event that
  represents the main issue(s)?
• -What have you tried so far to fix this? How did
  it work? What has it cost?
• -What have you done that has contributed to this
  issue, or made it worse?

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Taking A History

• Relationship history how did you meet, what
  attracted you, wedding day etc.
• What do you value in your relationship your
  partner, currently?
• (What did you value in your relationship your
  partner back then?)

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Taking A History

• On a scale of 1-10, how sure are you about
  staying in this relationship?
• On a scale of 1-10, how much work are you willing
  to do to improve the relationship?

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Stay or leave?

• Assess pros cons of each
• Have you given it your best shot?
• Whichever option you choose, youll need to make
  room for anxiety, doubt, worry etc
• Sitting on the fence metaphor
• Live by your values, whether you stay or leave

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Taking A History

• What sort of partner do you want to be?
• What sort of relationship do you want to build?
• Magic wand
• Visualise self as ideal partner vs self as
  reactive partner reflect share
• 80th birthday partner gives a speech
• Valued living questionnaire
• Share values

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Typical Core Values

• Connection
• Caring
• Contribution

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Values to Goals

• Whats a small step you can take?
• Whats a little thing you could do?

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Values to Goals

• If your partner actually does that, what
  difference would it make to you?
• How will you let them know that?

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Values to Goals

• If client makes positive changes
• What was that like for you?
• What happened to your relationship as a result?
• Whats another little step you can take?

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Values to Goals

• If client doesnt make positive changes
• What was that like for you?
• What happened to your relationship as a result?
• What got in the way?

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The Barriers to change F.E.A.R.

• Official ACT version
• Fusion
• Evaluation
• Avoidance
• Reason-giving

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The Barriers to change F.E.A.R.

• Alternative version
• Fusion
• Excessive expectations
• Avoidance
• Remoteness from values

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The Antidote to FEAR is DARE

• Defusion
• Acceptance
• Realistic expectations
• Embrace values

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Key Issues

• 4 approaches to any problem situation
• 1. Leave
• 2. Stay Change what can be changed live by
  your values
• 3. Stay Accept what cant be changed live by
  your values
• 4. Stay Give up increase your suffering
  through self-defeating behaviours

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Key Issues

• Behaviour change 101
• Whats in your control, and whats not?
• Carrot versus stick

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Key Issues

• Communication 101
• Ask clearly for what you want, (and explain why)
• Express clearly what you dont want, (and why)
• As you do this, be the partner you want to be!
• Boundaries consequences

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Key Issues

• When youre upset
• Breathe out
• I notice Im feeling x
• Im having the thought that ..
• Get present ground yourself
• If necessary leave the situation
• If you do leave, practise mindfulness
  acceptance (practise letting go of unhelpful
  stories)

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Key Issues

• Once grounded, ask yourself
• What sort of partner do I want to be? What are my
  values here?
• If I could be that ideal partner, I would respond
  by doing
• Then take action, guided by those values
• Visualise/write/rehearse those responses

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Key Issues

• In other words ACT
• Accept your thoughts and feelings
• Connect with your values
• Take effective action
• Or more simply
• Be present do what matters!

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Key Issues

• CONFLICT
• Stop arguments in session
• Do mindfulness then and there
• Whats your body doing? Breathe into it.
• Whats your mind saying? Name it.

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Key Issues

• CONFLICT
• What judgments does your mind make about
  him/her?
• What happens if you buy those judgments?
• Im making the judgment that ..

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Key Issues

• CONFLICT
• Being right versus being loving
• Im right youre wrong

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Key Issues

• CONFLICT
• Rigid rules
• What are your rules?
• What are your partners rules?
• Where did these rules come from?
• What happens when you fuse with them?

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Key Issues

• CONFLICT
• Defusion of Rigid rules
• Expect them
• Notice them
• Name them

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Key Issues

• CONFLICT
• Discuss inevitability
• Increase awareness of triggers
• Increase acceptance
• Pet arguments
• Name your stories
• Being right versus being loving
• But vs And
• Anger management if necessary

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Key Issues

• CONFLICT
• Repair attempts
• Whats the tiniest step you could take that might
  repair some of the damage?
• Acknowledge accept repair attempts
• John Gottman 7 Principles of Making Marriage
  Work

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Key Issues

• REFRAMING PROBLEMS
• How can I grow from this?
• What can I learn from this?
• What ACT skills will this enable me to improve?
• Imagine your partner is a teacher what is the
  lesson?

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Key Issues

• THE PERFECT PARTNER
• Do they exist?
• Do you always act the way you expect yourself to
  act?
• Acceptance exercise if I could give you a choice
  - a) no painful feelings, but no capacity to love
  or care b) you get to love and care, and that
  means that at times you have these painful
  feelings which would you choose?

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Key Issues

• CHANGING BEHAVIOUR
• Willingness to change, versus wanting to change
• Facilitate willingness through values
• Distinguish values-driven change from resentful
  change/ guilt-induced change/ trying to keep her
  happy/ trying to put up with him

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Key Issues

• CHANGING BEHAVIOUR
• Identify barriers FEAR
• N.B. reason-giving
• Discuss relapse
• When your partner stuffs up, how will you
  respond?

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Key Issues

• LOVE
• Distinguish the action of love from the feeling
  of love
• Magic wand

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Key Issues

• INTIMACY
• Be present
• Share valued activities
• Practise connection
• Eyes on

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Key Issues

• COMPASSION
• Kindness
• Commonality
• Mindfulness

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Key Issues

• FORGIVENESS
• Give yourself what was there before
• Do it for yourself
• Anger resentment costs
• Handle it with mindfulness let it come go

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Key Issues

• FORGIVENESS RITUAL
• Each partner writes-
• The thoughts, feelings memories Ive been holding
  on to are
• How holding on has hurt me our relationship
• Commitment to letting all this old stuff come and
  go without holding on to it
• Choose a special place, read it out, do
  something symbolic (eg burn it scatter the
  ashes) then do something to connect lovingly

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Key Issues

• TRUST
• Distinguish the action of trust from the
  feeling of trust (not really a feeling more a
  sense strong cognitive component)
• No control over feelings of trust only over
  the actions.
• Balance values around trust with values around
  self-protection